July 10, 2014
To: Meredith Rollins,
From: JC Smith, MA, DC
RE: Medical misinformation
Dear Ms. Rollins:
I suggest that you consider a retraction of a misleading statement in the August 2014 edition of Redbook. In an article, “What doctors tell their friends about preventing stroke” written by Lisa Mulcahy, in what was otherwise an informative article, she quoted a Dr. James Brorson, MD, associate professor of neurology at the University of Chicago Medicine, who warned readers about chiropractic adjustments:
“Although it’s rare, it’s possible to experience a stroke through dissection—the tearing of an artery in your neck. That’s why we neurologists generally advise against neck adjustments at the chiropractor.”
This swipe at chiropractors by Dr. Brorson is totally unsupported by research and smacks of chirophobia—the typical medical antipathy toward its major competition.
Despite the overwhelming support for chiropractic manipulation for neck problems,, this medical misinformer raised the unwarranted concern for strokes caused by manipulation simply to scare patients that demands a scholarly response.
This is a standard ploy by some physicians despite the research showing the extreme safety of chiropractic care. A 2010 study from England, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, raised the level of fear over chiropractic care when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.” Even his title was sensational albeit misleading.
Considering this covered 76 years and equates to 0.34 deaths per year—indeed, one-third of a person died each year from manipulative therapy. Instead of sounding an alarm to scare people as Ernst attempted, he should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods for the same diagnostic condition.
Ernst’s paper drew quick criticism from leading medical and chiropractic scholars. According to SM Perle, S French, and M Haas:
“Ernst ignored the evidence against a causal relation between spinal manipulation and death. Instead, he went boldly along a path of fear mongering and propaganda that we expect was predetermined to establish the dangers of CSM (cervical spinal manipulation).”
Another review from The Dartmouth Institute for Health Policy and Clinical Practice was equally critical:
“Three deaths were reported during the last 10 years of the study, so for that most recent time period, the absolute risk could be estimated to be 3/10 per 100 million, or three deaths for every billion chiropractic encounters…This rate is so low that it cannot possibly be considered significant…An interesting flip side to the research question might be: by undergoing a course of chiropractic spinal manipulation, how many patients were able to avoid death by avoiding complications of surgical intervention?”
According to research by Alan Terret, PhD, the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.
“We didn’t see any increased association between chiropractic care and usual family physician care, and the stroke,” said Frank Silver, one of the researchers and also a professor of medicine at the University of Toronto and director of the University Health Network stroke program.
In 2006, Jay Triano, DC, PhD, wrote about the stroke issue in his publication, “Current Concepts in Spinal Manipulation and Cervical Arterial Incidents,” that included 675 references and a comprehensive discussion of cervical artery injury and manipulation. He also came to the conclusion that chiropractic is very safe compared to medical treatments:
- The increased risk of death resulting from NSAID use is 1,500 times greater than the risk of tetraplegia following cervical SMT.
- On analysis, SMT as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of health care services.
- The risks of SMT pale when compared to known medical risks. Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public.
- Conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. 
The fact is malpractice insurance companies know which doctors are hurting patients since they pay the claims, and the actuaries show that chiropractors have the lowest malpractice rates among all spine practitioners. Chiropractors pay approximately $1,600 annually compared to spine surgeons who pay approximately $71,000 to over $200,000, which clearly suggests the safety of care provided by chiropractors.
I urge Redbook to consider a comprehensive article about the benefits of chiropractic care rather than allowing fear-mongering by MDs. Today chiropractors comprise the third-largest physician-level health profession in the nation and, after a century of illegal persecution by political medicine, our profession deserves better from the media.
As well, back pain is now the #1 disabling condition in the world due to the medical boycott of chiropractic care that has been shown to be safer, faster, cheaper and more effective than anything the medical world has to offer for 85% of back pain cases as the guidelines now recommend.
Considering the misuse of medical treatments causing the pandemic of opioid addiction that is euphemistically known as Hillbilly Heroin, the unproven use of epidural steroid injections, and the tsunami of ineffective spine surgeries done in the US today, I daresay Redbook would serve its readers better if it were to expose this rash of ineffective, expensive, and often disabling medical treatments for back pain rather than scaring people about chiropractic care.
I hope to hear from you on this matter.
 Masaracchio M, et al. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial. The Journal of Orthopaedic and Sports Physical Therapy, 2013 March.
 Korthais-de Bos IB, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner. British Medical Journal, 2013
 E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165
 SM Perle, S French, and M Haas, “Critique of Review of Deaths after Chiropractic, 4” Letters to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
 JM Whedon, GM Bove, MA Davis, “Critique of review of deaths after chiropractic, 5” Letter to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
 AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)
 National Chiropractic Mutual Insurance Company rate (2009)
 The Burton Report, “Why Spine Care is at High Risk for Medical-Legal Suits,” www.burtonreport.com/infforensic/MedMalSpCommonCause.htm